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Impact of PET-CT on Primary Staging and Response Control on Multimodal Treatment of Esophageal Cancer

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Abstract

Background

The predictive value of positron emission tomography-computed tomography (PET-CT) in primary staging and response control in patients with esophageal carcinoma (EC) is under discussion. In the present study initial staging and metabolic response of PET-CT was correlated with tumor regression and survival in patients with multimodal treatment of EC.

Methods

The authors conducted a retrospective analysis on a prospective database for 83 patients with EC (42 squamous cell, 39 adenocarcinoma, 2 anaplastic carcinoma) undergoing PET-CT for primary staging. Twenty-four of the patients underwent primary esophagectomy, 9 had palliative treatment, and 50 neoadjuvant radiochemotherapy (cisplatin, 5-fluorouracil; 50.4 Gy). The PET-CT study was repeated 6 weeks after induction of chemotherapy and compared with endoscopic ultrasound (EUS). For response control, the metabolic response (tumor standardized uptake value [SUV] reduction) was correlated with histopathologic (ypT0-4) and histomorphologic response (tumor regression) and survival.

Results

At primary staging 81 of 83 EC (97.5%) showed an increased SUV uptake correlating with the EUS tumor stage. Suspicious lymph nodes were detected in 51 (61.4%) patients by PET-CT and 66 (79.5%) were detected by EUS. Fifteen patients had additional findings on PET-CT examination leading to a change in therapy in 9 patients (10.3%). Of 50 patients receiving a second PET-CT study, a SUV reduction >50% correlated with major histomorphologic response (tumor regression grade 4, <10% vital tumor cells) and histopathologic response (ypT0 ypN0). Furthermore, these patients showed a significantly increased survival (33.1 ± 3.5 months) compared to non-responders (21.7 ± 3.3 months; p = 0.02) and patients after primary surgery (29 ± 3.2 months; p = 0.05).

Conclusions

The present study shows that PET-CT is a valuable tool for primary staging and response control in multimodal treatment of patients with EC.

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Author information

Authors and Affiliations

  1. Department of General and Visceral Surgery, Muenster University Hospital, Waldeyerstr. 1, 48149, Muenster, Germany

    Kirsten Thurau, Daniel Palmes, Norbert Senninger & Matthias Bruewer

  2. Department of Nuclear Medicine, Muenster University Hospital, Albert-Schweitzer Str. 33, 48149, Muenster, Germany

    Christiane Franzius

  3. Gerhard Domagk Institute of Pathology, Muenster University Hospital, Domagkstr. 17, 48149, Muenster, Germany

    Evgeny Minin

  4. Department of Clinical Radiology, Muenster University Hospital, Albert-Schweitzer Str. 33, 48149, Muenster, Germany

    Kai Uwe Juergens

Authors
  1. Kirsten Thurau
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  2. Daniel Palmes
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  3. Christiane Franzius
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  4. Evgeny Minin
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  5. Norbert Senninger
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  6. Kai Uwe Juergens
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  7. Matthias Bruewer
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Corresponding author

Correspondence to Matthias Bruewer.

Additional information

Kirsten Thurau and Daniel Palmes contributed equally to this study.

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Thurau, K., Palmes, D., Franzius, C. et al. Impact of PET-CT on Primary Staging and Response Control on Multimodal Treatment of Esophageal Cancer. World J Surg 35, 608–616 (2011). https://doi.org/10.1007/s00268-010-0946-x

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  • DOI: https://doi.org/10.1007/s00268-010-0946-x

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